1. Complications of Laser Vitreolysis
Scott Geller MD Feike Gerbrandy MD
Fort Myers, Florida Amsterdam, Netherlands
In spite of two decades of reports of successful outcomes for laser vitreolysis, the Ophthalmic community has been slow to adopt this treatment modality, in part due to lack of large clinical studies of complication rates.
We reviewed the medical records of 3 Ophthalmologists who performed laser vitreolysis during the year 2011 on 542 eyes of 502 patients.
Surgeon 1 (SG)
25 years experience
LASAG Microruptor II YAG
691 sessions
219 patients
232 eyes average
4.7 mJ/pulse
435 p/session
Surgeon 2 (JK)
12 years experience
Ellex YAG
308 sessions
140 patients
140 eyes average
8.0 mJ/pulse
150 p/session
Surgeon 3 (FG)
3 years experience
Zeiss Visulase YAG
302 session
143 patients
170 eyes average
6.8 mJ/pulse
378 p/session
OBSERVED COMPLICATIONS
3 eyes elevated IOP (>30) 1 phakic, 2 pseudophakic; 7050 mJ total average engergy
2 patients (1 phakic, 1 pseudophakic) returned to normal IOP after 5 months medical therapy
1 patient required cyclodialysis surgery after 2 months unsuccessful (IOP 36) medical therapy
3 eyes elevated IOP (2phakic, 1 pseudophakic), mJ total average energy
2 eyes retinal hematoma with no visual sequelae (1 eye had BRVO 3.5 months post laser)
1 eye retinal tear 2 weeks post laser 2 sessions 2729 mJ 806 pulses
1 eye presumed lens opacity unconfirmed by a second ophthalmologist
CONCLUSION
Experienced surgeons have a very low complication rate
Retinal detachment is NOT a significant issue with laser vitreolysis
Elevated intraocular pressure is a major concern, more so with high power/pulse settings in pseudophakes

2. Feike Gerbrandy, Amstelveen
Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes
Complicaties van eerste 150 ogen (1) vergeleken met volgende 350 ogen(2):
Groep 1: direct complications 2.6%
3x retinal hit
1x traumatic cataract
late adverse events: 1x retinal detachment (0,66%),
1x elevated IOP (0,66%).
Groep 2: direct complications 0%
0x retinal hit
0x traumatic cataract
late adverse events: 2x retinal detachment (0,57%)
4x elevated IOP (1,14%)
Conclusie: YAG vitreolysis heeft laag risico indien uitgevoerd door een ervaren oogarts. Er is een lange leercurve. Dit pleit ervoor dat floaterlaser als subspecialisme door een beperkt aantal ervaren oogartsen moet worden uitgevoerd.
Oogdrukstijging staat los van ervaring.
Feike Gerbrandy, Amstelveen

3. Feike Gerbrandy, Amsterdam
Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes
Complicaties van eerste 150 ogen (1) vergeleken met volgende 350 ogen(2):
Groep 1: direct complications 2.6%
3x retinal hit
1x traumatic cataract
late adverse events: 1x retinal detachment (0,66%),
1x elevated IOP (0,66%).
Groep 2: direct complications 0%
0x retinal hit
0x traumatic cataract
late adverse events: 2x retinal detachment (0,57%)
4x elevated IOP (1,14%)
Conclusie: YAG vitreolysis heeft laag risico indien uitgevoerd door een ervaren oogarts. Er is een lange leercurve. Dit pleit ervoor dat floaterlaser als subspecialisme door een beperkt aantal ervaren oogartsen moet worden uitgevoerd.
Oogdrukstijging staat los van ervaring.
Feike Gerbrandy, Amsterdam

4. Feike Gerbrandy, Amsterdam
Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes Feike Gerbrandy, MD
Background:
Floaterlaser, YAG vitreolysis or nebulotrypsia is a laser treatment of vitreous floaters. Worldwide there are only a handfull of ophthalmologists able to perform this treatment. They founded the International Society of Vitreous Laser Surgery (ISVLS).
The members of the ISVLS cooperate in research and treatment protocols.
Feike Gerbrandy started doing floaterlaser in Since then he has treated about 750 eyes
In a recent study by his team (submitted for publication) about 86% of patients are satisfied with the result.
These data show that most disturbing floaters can be succesfully treated by laser.
As with many treatments: after the pioneers have showed the way followers will come: more ophthalmologists will want to learn floaterlaser.
Feike Gerbrandy, Amsterdam

5. Feike Gerbrandy, Amsterdam
Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes
First 500 cases were analysed for complications:
First 150 eyes (group 1) were compared with following 350 (group 2):
Group 1: direct complications 2.6%
3x retinal hit
1x traumatic cataract
late adverse events: 1x retinal detachment (0,66%),
1x elevated IOP (0,66%).
Group 2: direct complications 0%
0x retinal hit
0x traumatic cataract
late adverse events: 2x retinal detachment (0,57%)
4x elevated IOP (1,14%)
Feike Gerbrandy, Amsterdam

6. Feike Gerbrandy, Amsterdam
Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes
Evaluation:
In the first 150 eyes the lens or retina was hit in 2.6% of eyes, versus 0% in the following 350 eyes.
This clearly illustrates the learning curve of this technique.
Conclusion: Floaterlaser of YAG vitreolysis or nebulotrypsia is a low risk and safe procedure if performed by an experienced ophthalmologist. The patient demand for this procedure is increasing.
Feike Gerbrandy, Amsterdam

7. Feike Gerbrandy, Amstelveen
Floaterlaser
Gerbrandy
Number of eye
satisfied
Not satisfied
Retinal detachment
blind
Follow up
Laser
255
85.1%
14.9%
0.39% 0%
343 day
11.2 month
PPV
341
88.4%
8.89%
6.16%
2.6%
550 day 18 months
Feike Gerbrandy, Amstelveen

8. Basiscursus Floaterlaser 2013 Morgen 10.30 Zaal 1
Feike Gerbrandy
Opsis Oogziekenhuis Amsterdam
Feike Gerbrandy, Amsterdam